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Highlights

A video capsule endoscopy can help doctors better diagnose the cause of gastrointestinal bleeding.

The video capusle can investigate "no man's land" - the small bowel area - where a colonoscopy and a regular endoscopy cannot.

However, patients need to fast for 12 to 16 hours and prep their bowels to improve visualization.

Gastrointestinal bleeding is almost always a cause for concern; or at the very least a trip to the emergency room. However, emergency rooms often lack the traditional diagnostic tests needed to visualize the entire bowel. A 2013 pilot study published in the Annals of Emergency Medicine suggested that using an imaging test called video capsule endoscopy in the ER can help doctors better diagnose the cause of bleeding and improve care.

Video capsule endoscopy involves swallowing a pill-sized video camera. The study, which examined 19 adults compared video capsule endoscopy with a traditional endoscopy to compare the results. Researchers found video capsule endoscopy to be an accurate tool for ER doctors to use.

Video Capsule Endoscopy: Why It’s Needed

Video capsule endoscopy has been available since 2001, and it has become an important gastroenterology test for diagnosing digestive disorders, particularly bowel diseases such as Crohn’s disease.

The two traditional ways doctors look for bleeding in the emergency room setting are with an endoscopy through the mouth or a colonoscopy, said Christopher Stark, DO, medical director of emergency medicine at Penn State Hershey Medical Center in Hershey, Pa.

An endoscopy allows the doctor to examine the gastric area and first part of the intestines, Dr. Stark said, which is about three to six feet of the gastrointestinal (GI) tract. A colonoscopy is performed through the rectum to visualize the large bowel. While endoscopy and colonoscopy are both great tests, they leave the small bowel area uninvestigated.

Currently, ER doctors need to use a specific imaging study that is not always readily available, called a tagged red blood cell study, if they need to view that “no man’s land,” he added.

Video capsule endoscopy, however, allows physicians to see everything covered by an endoscopy and colonoscopy, along with the “no man’s land” in between. This is particularly helpful when done in the ER because it allows for immediate evaluation of the possible source of bleeding.

“It speeds up diagnosis and allows for treatment to happen sooner,” Stark said.

No one in the study who was approached to undergo capsule endoscopy declined it. Furthermore, most patients tolerated it well, and it was associated with a low complication rate.

There are some downsides to using the video capsule though. It only allows physicians to view the area and identify problems -- a second procedure is needed to administer treatment. A single endoscopy or colonoscopy, on the other hand, can be used for both diagnosis and treatment, Stark said, so when the doctor finds the source of the bleeding, it can be treated right away.

Another limitation of video capsule endoscopy is the need for patients to fast for 12 to 16 hours and prep the bowel to improve visualization. It’s difficult to have a patient sitting in an emergency room for that length of time before performing the test.

There is a way around it for some hospitals, however. Hershey has a program called emergency department observation, which allows patients to be admitted to the hospital for up to 23 hours. This program would be perfect for this type of patient who needs a video capsule endoscopy, Stark explained. Not all hospitals, however, have an observation unit in place.

The study authors stated that their pilot study shouldn’t change clinical practice yet, but as more research and larger studies are done, it could lead to a change in the way things are done in the ER.

Stark said that both the video capsule endoscopy and the tagged red blood cell study have their place. “I don’t think this pill has been validated yet to replace that [imaging] study,” he said.

There is potential, though, that being diagnosed with GI bleeding in the ER in the future could be as simple as swallowing a pill-sized camera.

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